ADHD is the most commonly identified childhood mental health and behavioral disorder in primary care. ADHD can present with inattentive symptoms yet, anxiety is even more prevalent but under-diagnosed. The exponential increase in children labeled with ADHD and on medication demands critical examination. ADHD guidelines exist and physician adherence to these guidelines has greatly improved. However, little work has been done to leverage existing systems to condense and integrate various guidelines into the busy workflow of outpatient pediatric practice. We will build upon our existing computer decision support system (CDSS), the Child Health Improvement through Computer Automation (CHICA) system. The proposed work will demonstrate the feasibility of revising an established system to improve the healthcare to children with inattentive symptoms. Yet, implementation of a new module by itself may not lead to optimal user uptake. Therefore, the proposed application will build and pilot an anxiety module within its existing ADHD algorithm and integrate continuous quality improvement efforts into the development and implementation process. The objective of this application is to refine CHICA to improve the diagnostic process of screening children with inattentive symptoms by employing iterative quality improvement strategies with physician and clinic users and periodic family feedback about the screening process itself. The central hypothesis is that by refining current diagnostic processes within CHICA, we will improve the identification of anxiety among children with inattentive symptoms, decrease the inappropriate diagnosis of ADHD, and improve overall treatment for children with inattention. The rationale for this application is that the current care of children with inattentive symptoms i a constant challenge for busy primary care physicians and results in suboptimal identification and treatment. The specific aims of the study are: Aim 1: Expand and modify the CHICA decision support system to improve the diagnostic processes for screening of children with inattention, including screening in the waiting room, physician prompts, and tailored diagnostic and brief counseling tools. Aim 2: Create a quality improvement learning collaborative that leverages CHICA's clinical decision support, including providing run charts for each physician of their screening, referral and medication prescribing patterns paired with facilitated discussion to share strategies to improve the diagnostic process and evaluate physician and caregiver satisfaction with the CHICA anxiety module. Aim 3: Examine the effect of the CHICA anxiety module on the diagnostic processes of physicians when screening children with inattentive symptoms.